Individual
MR. MANOLITO JOSE PORTILLO II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8501 NW MADISCHE RD, LAWTON, OK 73507-1221
(580) 492-3614
Mailing address
PO BOX 908, CO PREVENTION AND RECOVERY, LAWTON, OK 73502-0908
(580) 492-3614
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
OK
175T00000X
Peer Specialist
—
—
Other
Enumeration date
01/15/2020
Last updated
01/15/2020
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